Government may have leaked billion dollar Medicare decision

At least 436 employees of the Department of Health and Human Services received advance word of an upcoming Medicare decision, and now federal investigators are looking into whether they tipped off Wall Street investors.

A review of emails by Republican Sen. Charles E. Grassley of Iowa found that hundreds of HHS employees received advanced word of a billion-dollar Medicare decision weeks before the official announcement, according to the Washington Post. Trading in Humana and other private health insurers’ stock spiked in the period before the announcement.

Insiders at HHS had advance word of the Centers for Medicare and Medicaid Services’ April 1 decision to spend an additional $8 billion of the taxpayers’ money on the private-sector Medicare Advantage program. HHS officials told the post this was necessary due to the complexity of Medicare policy. Grassley wants to know how Wall Street investors learned of the federal ruling.

The Justice Department and the Securities and Exchange Commission have launched investigations to find out whether Wall Street investors gained prior access to knowledge of the decision.

Former director of the Medicaid program Thomas Scully claims it is likely that hundreds of people had access to the billion-dollar verdict, as it was a highly complex decision.

Grasseley told Post his office found 436 DHS employees knew of the decision nearly two weeks before it became public.

“This should sound an alarm,” Grassley told the newspaper. “It should result in better controls to avoid unfair access to information that the average investor could never tap.”

Published: May 30, 2013

In his May 26 column, “Obamacare’s Other Surprise,” Thomas L. Friedman discusses how data that support medical decision-making and collaboration, dovetailing with new tools in the Affordable Care Act, are spurring the innovation necessary to deliver improved health care for more people at affordable prices.

This is just another example of how public policy is driving a smarter health care system focused on the quality of care, not the quantity of care delivered. That means increasing transparency and accountability, avoiding costly mistakes and readmissions, keeping patients healthy, and enabling new payment and care delivery models, like accountable care organizations, to work.

Last week, we reached an important milestone in the adoption of health information technology, which is a critical underpinning to this larger strategy.

More than half of all doctors and other eligible providers and nearly 80 percent of hospitals are using electronic health records to improve patient care — an increase of at least 200 percent since 2008.

There is much work yet to be done to change the habits of health care, and to continue the push toward secure information sharing, but by using policy to leverage market-based innovation, we are playing to America’s greatest strength to solve our most pressing problems.

FARZAD MOSTASHARIWashington, May 28, 2013

The writer is national coordinator for health information technology for the Health and Human Services Department.

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Eleven years ago, a toddler admitted with cough and cold developed a gangrenous arm which had to be amputated

The Manipal Hospital in Bangalore and its four doctors have been directed by the apex consumer forum to pay Rs. 5.1 lakh towards rehabilitation of a child whose gangrenous right forearm was amputated due to their negligence.

The National Consumer Disputes Redressal Commission (NCDRC) observed that due to the medical negligence of the hospital and its doctors — paediatrician Meera Ramakrishnan, vascular surgeon Vasudeva Rao, consultant paediatric Arvind Shenoy and paediatric surgeon Jayanth Iyengar — “the child has to spend the entire life without her right forearm”. “Doctors have not been able to explain how the gangrene occurred. Therefore … medical negligence is clearly established.”

A bench presided by Justice Ashok Bhan directed the hospital and doctors to jointly pay Rs. 5 lakh to the parents “for the rehabilitation of baby Sandria by providing artificial limb and proper education and care” and also ordered Manipal Hospital to pay Rs. 10,000 as cost.

The order came on the appeals filed by the parents, Alfred and Rani Benedict, and the hospital and doctors, both sides challenging the order of the State commission which had directed the hospital and doctors to pay Rs. 5.1 lakh as compensation.

The parents, in their complaint before the Karnataka State Consumer Disputes Redressal Commission had submitted that in August 2002 they had taken their then two-year-old daughter, who was suffering from cold and cough, to Dr. Shenoy who had advised them to admit the child in Manipal Hospital, Bangalore.

Thereafter, she was diagnosed as suffering from pneumonia and was given intravenous fluids through a needle in her right arm. The parents alleged the needle blocked the blood supply, turning the forearm gangrenous, resulting in amputation.

While the parents had sought enhancement of compensation from the NCDRC, the opposite party contended they had not been negligent and the unfortunate complication occurred as the patient, who had pneumonia, had gone into septic shock.

The NCDRC rejected the hospital’s contention, saying “it appears they (doctors) have not followed the standards of medical practice”.

By Wayne Lowell

JUNE 10, 2013

Providing health care to the poor increasingly means providing health care to non-English speakers, and that’s a challenge that is about to get more challenging.

According to the US Census, more than 55 million people speak a language other than English at home. In Massachusetts, the number is 1.2 million. In the City of Boston, one in three residents speak another language.

At Cambridge-based Senior Whole Health, which provides health care to people who quality for both MassHealth and Medicaid and is known as a Senior Care Options plan, two out of three of our members do not speak English. The number of languages spoken by our membership is more than 30.

Navigating our complicated health care system is a challenge for anyone. For a non-English speaking person, the task is overwhelming – and can be deadly.

Non-fluency in English is associated with lower use of preventive services, higher utilization of expensive emergency room care, less ability to self-manage chronic diseases – and higher mortality, according to the Journal of the American Medical Association. In fact, according to JAMA, reading fluency is a more powerful variable than education for examining the association between socioeconomic status and health.

Navigating the system will get even more complicated next year when individuals and small businesses will be required to purchase health insurance under federal health reform. That will require them to compare and contrast various private health insurance policies through exchanges set up by the new law.

Meanwhle, immigration reform could add another seven million people, many of them not fluent in English, to Obamacare.

But there is a path to success. We have already helped over 10,000 people successfully navigate the health care system. Our model provides all-inclusive care directed by a case manager who provides one-stop shopping for the patient and his or her family in their native language. We emphasize preventive care and provide non-medical services, such as bilingual exercise classes, that support a healthy lifestyle.

Not only is this model keeping people healthier, but it’s saving taxpayer dollars by keeping poor seniors out of nursing homes longer and reducing hospital admissions by 25 percent, according to a study conducted for MassHealth.

Providing health care to the poor will require a new mindset about how to deliver — and define — health care.

This data spotlight provides an overview of Medicare Advantage enrollment patterns in March 2013 and examines variations by plan type, state, and firm. It also analyzes trends in premiums paid by beneficiaries enrolled in Medicare Advantage plans, including variations by plan type, and describes the out-of-pocket limits and prescription drug coverage in the Part D “donut hole” provided by the plans in 2013.

This analysis finds that 14.4 million Medicare beneficiaries are enrolled in private Medicare Advantage plans in 2013, up nearly 10 percent from 2012. Since 2010, enrollment in Medicare Advantage plans has grown by 30 percent in spite of concerns that the payment changes enacted in the 2010 Affordable Care Act would lead to significant reductions in enrollment. While about 28 percent of Medicare beneficiaries nationally are now enrolled in Medicare Advantage plans, the share varies greatly by state — ranging from 49 percent in Minnesota to less than 1 percent and 3 percent in Alaska and Wyoming, respectively. Medicare Advantage enrollment continues to be concentrated among a small number of organizations. Beneficiaries in Medicare Advantage Prescription Drug plans (MA-PDs) pay about the same premium ($35 per month) in 2013, on average, as plan enrollees in 2012, with somewhat lower premiums in health maintenance organizations (HMOs) and higher premiums in other plan types. While the vast majority of beneficiaries (98%) have access to a MA-PD with no premium, slightly more than half (55%) of beneficiaries are enrolled in a zero-premium plan in 2013, varying by plan type and locale. All Medicare Advantage plans have a limit on out-of-pocket spending, and nearly half of all Medicare Advantage enrollees are in a plan with a limit at or below $3,400 per year.

The analysis is authored by researchers at Mathematica Policy Research Inc. and the Kaiser Family Foundation.